Village Name:________________________

Village Number: |_| |_|
 

Note to supervisor: All questions in this table follow the same format. First they ask how far it is to the nearest facility from the center of the village. Then they ask about the frequency of public transport to those places. If the facilities/people are in the village, the supervisor should not ask the secondary question.
 

VC. Commerce, communications and official facilities
L1	About how many people live in this village (not including children)?			Number of residents_________
x		VCax	VCbx	VCcx	VCdx
	How far is the nearest:	Daily Market (where many people sell vegetables)?	Telephone	Homa Bay	Bank
1	Kilometers (Kms)	Kms ___	Kms ___	Kms ___	Kms ___
2	On a typical weekday morning, about how many buses or minibuses go there from somewhere in the village (eg. the center)?	__	__	__	__
	How far is the nearest:	Post Office?	Police Station?	Bar (where there are bargirls)	Money lender/ where go to raise money?
3	Kilometers (Kms)	Kms ___	Kms ___	Kms ___	Kms ___
4	On a typical weekday morning, about how many buses or minibuses go there from somewhere in the village (eg. the center)?	__	__
VH. Health Institutions
x		VHax	VHbx	VHcx	VHdx
	How far is the nearest:	Hospital	Health center/ Dispensary	Family Planning Clinic	MCH clinic
1	Kilometers (Kms)	Kms ___	Kms ___	Kms ___	Kms ___
2	On a typical weekday morning, about how many buses or minibuses go there from somewhere in the village (eg. the center)?	__	__	__	__

 
 
 

VS. Schools
x		VSax	VSbx	VScx
	How far is the nearest:	Primary school	Secondary school	Place with adult literacy classes
1	Kilometers (Kms)	Kms ____	Kms ____	Kms____
2	On a typical weekday morning, about how many buses or minibuses go there?	_____	_____	_____

VPH. Public Health
VPH1	Have large scale public health initiatives been carried out in this village during the last 3 years (eg. Vaccination campaigns, sanitation initiatives)?	Yes ............... 1 No ................ 0	-> VW1
VPH2	What sort of initiatives?	______________________

VW. Water
VW1	Where do most people in the village get their water from?	Borehole ......................... 1 Protected well ................. 2 Pump .......................... 3 Spring/ Unprotected well 4 Lake....................................5 Other .....................6 Specify_____________
VW2	About how many minutes do most people have to walk to get water?	(WRITE NUMBER MINUTES) _____

VF Funerals
VF1	How many people in this village have died in the past month ?	Number____________
VF2	How many people in this village died in the past year?	Number _____
VF3	How many of these were children?
VF4	How many of these were old folks?
VF5	How many were between age 20-50?
VFP. Family Planning
VFP1	In general, does the local chief appear to approve or disapprove of family planning?	Strongly approves of it .... 1 Mainly approves of it ...... 2 Is neutral ........................ 3 Mainly disapproves of it .. 4 Strongly disapproves of it.. 5
VFP2	Does the chief's wife use family planning?	Yes...............1 No.................0

VA. Agriculture and Land-Use
VA1	Land transferred outside family?	_________________________
VA2	Has there been a change during the last 10 years in the average size of land holdings?       On Average what proportion of maize for a family is bought and what proportion is grown by the family?	Increased ........... 1 About the same ... 2 Decreased a little ... 3 Decreased significantly.. 4
VA3	What are the main crops that people plant in this village?	_________________________ _________________________
VA4	Have any new crops or varieties been introduced in the last 10 years?	Yes ...................... 1 No ....................... 0	-> VA6
VA5	Which crops?	_________________________ _________________________
VA6	How many times a year can land be sown?	(WRITE NUMBER) ________
VA7	Is there any land that is not planted but that is allowed to (a) lie fallow or (b) be used for pasture?	Lay fallow..................... 1 Used for pasture.............. 2 Both................................ 3 Neither........................... 0
VA8	What proportion of farmers here use chemical fertilizers?	Proportion __________
VA9	Where do they get the fertilizer?	_________________________ _________________________
VA10	What is the main method that people here use to sell their produce?	Informally in the village .......... 1 At their own market stall/shop in the village .................................... 2 In another village or town ....... 3 To a seller in the village .......... 4 To a seller in another village/town ..5
VA11	On average, do you think that the people in this village are, poorer, wealthier, or about the same as the people in other villages in the sublocation?	Poorer ........................ 1 About the same .......... 2 Wealthier ................... 3
VA12	Over the last 10 years have people in this village gotten poorer, richer, or stayed about the same?	Poorer ........................ 1 About the same .......... 2 Wealthier ................... 3

VR. Religious Groups
VR1	Which religious groups have places of worship (eg. churches) in the village?	A. ________________________ B. ________________________ C. ________________________ D. ________________________ E. ________________________ F. ________________________ G. ________________________
VR2	Were any of these funded (in part or in full?) by foreign monies?	Yes No A. 1 0 B. 1 0 C. 1 0 D. 1 0 E. 1 0 F. 1 0 G. 1 0
VR3	Have there been any big arguments between some of the religious groups in the last few years?	Yes .................. 1 No ................... 0	-> END
VR4	Who was the last argument between?	_____________________________ _____________________________
VR5	What was it about?	_____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________